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REQUEST FOR SPECIAL EDUCATION DUE PROCESS HEARING AND REQUIRED NOTICE - DOC

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									REQUEST FOR SPECIAL EDUCATION DUE PROCESS HEARING AND REQUIRED NOTICE The Individuals with Disabilities Education Improvement Act of 2004 (IDEA), Title 20, United States Code Section 1415(b)(8) requires that the Special Education Bureau of the New Mexico Public Education Department develop a model form to assist parents in requesting a special education due process hearing and in providing notice required by Section 1415(b)(7) of those amendments. You may use this form to satisfy this notice requirement, but any written request that complies with Section 1415(b)(7) and 6.31.2.13(I)(5) NMAC may be substituted for this form. Student’s Full NAME and DATE OF BIRTH: Parent, Guardian, or Surrogate Parent Full Name:

Student’s Address or Contact Information if the Student is Homeless:

Parent, Guardian, or Surrogate Parent Address:

District Student Attends:

District Mailing Address:

School Student Attends:

District/School Representative or Contact: (if known)

Issues to be Resolved : (check all boxes that apply): The Identification of the student as a student with a disability needing special education or related services under the IDEA. The Evaluation to determine whether the student has a disability under the IDEA, and/or the nature and extent of the special education and related services the student needs. The Educational Placement of the student in special education or related services under IDEA. The provision of a Free Appropriate Public Education to the student under IDEA. Describe the Nature of the Problem(s) of the Child Related to the Proposed or Refused Initiation or Change and the Facts Relating to the Problem(s): Include relevant dates, specific events, and/or persons involved.

Due Process Hearing August 27, 2007 Page 1 of 4

Describe the efforts you have made to resolve your dispute(s) with your child’s school before filing the request for a Due Process Hearing.

Proposed Resolution: (check all boxes that apply): An order directing the district/charter to take specific actions required by the IDEA An order directing the district/charter to reimburse the cost of private educational services. An order directing the district/charter to provide compensatory special education or related services. Other, please specify:

Description of the Proposed Resolution: Describe the complete remedy and resolution of the problem you want the hearing officer to order (to the extent known to you at this time).

Due Process Hearing August 27, 2007 Page 2 of 4

Contact Information for Authorized Representative: Name: Mailing Address: Phone Number(s): Fax Number: or -

Capacity of Authorized Representative: (check one): Attorney for Petitioner Bar Number: Non-attorney Representative of Petitioner Next Friend of Petitioner (Parent, Guardian, or Surrogate Parent) Self (Student with a Disability 18 years or older)

State:

I declare that the foregoing is true and correct to the best of my knowledge after reasonably and diligent inquiry.

Authorized Representative(s) Signature

Date

MAIL OR FAX COPIES TO: Special Education Bureau New Mexico Public Education Department 120 S. Federal Place, Room 206 Santa Fe, New Mexico 87501 FAX: 505-954-0001

AND School District or Charter

Due Process Hearing August 27, 2007 Page 3 of 4

STATEMENT AUTHORIZING REPRESENTATION SPECIAL EDUCATION DUE PROCESS REQUEST

TO:

Denise Koscielniak, State Director of Special Education New Mexico Public Education Department 120 S. Federal Place, Room 206 Via Fax: 505-954-0001 to represent me in

I herby authorize (Authorized Representative(s) filing an IDEA due process complaint against on behalf of (Child)

(School District) .

(Parent, Guardian, or Surrogate Parent) Date:

Due Process Hearing August 27, 2007 Page 4 of 4


								
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